Advancing obstetric and neonatal care in a regional hospital in Ghana via continuous quality improvement

Ridge Regional Hospital, Ghana Health Service, Accra, Ghana.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics (Impact Factor: 1.54). 01/2012; 116(1):17-21. DOI: 10.1016/j.ijgo.2011.08.010
Source: PubMed


To reduce maternal and neonatal death at a large regional hospital through the use of quality improvement methodologies.
In 2007, Kybele and the Ghana Health Service formed a partnership to analyze systems and patient care processes at a regional hospital in Accra, Ghana. A model encompassing continuous assessment, implementation, advocacy, outputs, and outcomes was designed. Key areas for improvement were grouped into "bundles" based on personnel, systems management, and service quality. Primary outcomes included maternal and perinatal mortality, and case fatality rates for hemorrhage and hypertensive disorders. Implementation and outcomes were evaluated tri-annually between 2007 and 2009.
During the study period, there was a 34% decrease in maternal mortality despite a 36% increase in patient admission. Case fatality rates for pre-eclampsia and hemorrhage decreased from 3.1% to 1.1% (P<0.05) and from 14.8% to 1.9% (P<0.001), respectively. Stillbirths were reduced by 36% (P<0.05). Overall, the maternal mortality ratio decreased from 496 per 100000 live births in 2007 to 328 per 100,000 in 2009.
Maternal and newborn mortality were reduced in a low-resource setting when appropriate models for continuous quality improvement were developed and employed.

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Available from: Medge D Owen, Mar 05, 2014
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    • "A recent study to improve quality of care in hospitals in Malawi suggests that staff stability, leadership, training, and ongoing support from district staff and external coaches trained in quality improvement methods are necessary to sustain the process [33]. Generally, there is little evidence regarding how quality improvement initiatives can improve outcomes [34-36]. It is important to understand how our intervention is or is not effective, and we will monitor quality of care as it could be an important driver of reduction in the first delay. "
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    Full-text · Article · Feb 2014 · BMC Pregnancy and Childbirth
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    • "In the absence of high level support local commitment can improve outcomes. The majority of audit and feedback based strategies did not involve large monetary investments, but instead enabled facilities to make the most of their existing resources [22,23,25-27,29-34]. Leigh et al [50] note that locally suggested equipment substitutions reduced costs and allowed for quicker implementation of new procedures due to easier procurement processes. "
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    ABSTRACT: Efforts to scale-up maternal and child health services in lower and middle income countries will fail if services delivered are not of good quality. Although there is evidence of strategies to increase the quality of health services, less is known about the way these strategies affect health system goals and outcomes. We conducted a systematic review of the literature to examine this relationship. We undertook a search of MEDLINE, SCOPUS and CINAHL databases, limiting the results to studies including strategies specifically aimed at improving quality that also reported a measure of quality and at least one indicator related to health system outcomes. Variation in study methodologies prevented further quantitative analysis; instead we present a narrative review of the evidence. Methodologically, the quality of evidence was poor, and dominated by studies of individual facilities. Studies relied heavily on service utilisation as a measure of strategy success, which did not always correspond to improved quality. The majority of studies targeted the competency of staff and adequacy of facilities. No strategies addressed distribution systems, public-private partnership or equity. Key themes identified were the conflict between perceptions of patients and clinical measures of quality and the need for holistic approaches to health system interventions. Existing evidence linking quality improvement strategies to improved MNCH outcomes is extremely limited. Future research would benefit from the inclusion of more appropriate indicators and additional focus on non-facility determinants of health service quality such as health policy, supply distribution, community acceptability and equity of care.
    Full-text · Article · Dec 2013 · PLoS ONE
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